WHOOP Podcast - Inside the Ethics of Biological Aging with Dr. Raiany Romanni-Klein

Episode Date: February 18, 2026

On this months edition of The WHOOP Podcast, WHOOP SVP of Research, Algorithms, and Data Emily Capodilupo sits down with longevity researcher and bioethicist Dr. Raiany Romanni-Klein to explore how society should be handling aging.Dr. Romanni-Klein breaks down why aging may be the most underfunded and misunderstood driver of suffering in modern society, and why treating it as a solvable biological problem could transform our economy, healthcare system, and future. From the ethics of longevity to the policy failures slowing innovation, Dr. Rommani-Klein explains that extending healthspan is all about reducing disease, caregiver burden, and economic strain.The conversation dives into the science and economics of aging, including why brain health may offer the highest return on investment, the opportunities of the pharmaceutical industry in creating longevity drugs, and why exercise and diet remain the most powerful longevity tools we have today. Emily and Dr. Rommani-Klein the regulatory and incentive barriers preventing large-scale aging trials and what would need to change for society to treat aging as a disease.(00:33) Introduction to Dr. Raiany Romanni-Klein(01:17) Where Is The Intersection of Ethics and Longevity Science? (02:05) The Aging Population and Reduced Birth Rates(04:31) WHOOP Podcast Rapid Fire Q’s(07:42) Ethics Around Technological Evolution: What Is Best For Longevity & Society(11:41) Changing Perspectives on Longevity(17:42) What Biomarkers Are Important For Longevity(22:09) Incentives For Pharmaceutical Companies to Invest In Longevity Science(24:51) Do People Have The Agency To Extend Healthspan?(27:16) Policy Issues Affecting Longevity(34:18) The Influence of Longevity Drugs Like GLP-1s(42:10) Is There A Better System The US Should Be Following?(45:17) What More People Need To Know About Longevity Science(46:27) Running Models and Simulations To Understand Longevity(53:22) The Future of Longevity Science: What Excites Dr. Romani-KleinFollow Dr. Raiany Romanni-Klein:WebsiteLinkedInInstagramSupport the showFollow WHOOP: Sign up for WHOOP Advanced Labs Trial WHOOP for Free www.whoop.com Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

Aging is universal. Scientifically, there's no good reason why you wouldn't call it a disease. I've always been fascinated by this idea that we can tweak life and improve it. A lot of people hear longevity or longevity supplements, and they roll their eyes a little bit like billionaires wanting to be immortal. That sort of gives this whole field a bad rap. Right now, there's this perception that it's only going to benefit to the top 1% of our civilization. That's why I do think more work needs to be done.

My biggest bioethical concern when it comes to human longevity is... Hi, everybody. I'm Emily Capitaluppo, Woop Senior Vice President of Research Algorithms and Data. And today I am joined by a very good friend of mine, Dr. Rainey Romani Klein. Rainey is a researcher, philosopher, and bioethicist working at the intersection of longevity, ethics, and public policy. She has done a wide-ranging number of just incredibly cool things from helping design the $101 million X-Prize for Health.

Her work has been published in the world's leading academic journals as well as mass media like The Washington Post. And she is working on her very first book, which I am so excited to read. So without further ado, Rainey, welcome to the Woot Podcast. Thank you, Emily. It's wonderful to be here. I want to jump in with a little bit about you. What does it mean to do work at the intersection of ethics and health span?

The root of the word ethics comes from the Latin custom or habit. So what is ethical is by and large what has been customarily done for millennia. But that always seemed like an insufficient definition for me. I always thought that there's arguably no question more important than what we should do as a species and what we should become as a species. So I've always been fascinated by this idea that we can tweak life and improve it. And, you know, are there any boundaries that we should be mindful of? And how do we increase human flourishing and diminish suffering? That is the question that I am fascinated about.

And I've always wanted to answer. One of the things you and I have talked about a lot that's interesting is there's a, I think you would say, misconception that, you know, there's this fear that if we all kind of live another 50 years or another 100 years longer, we're going to have this really aging population and Social Security can't keep up. And, you know, there's already concerns about, like, birth rates being low in the aging population. So how should people think about that? How does your work come in?

So we all increasingly know that we have plummeting birth rates and that there's a population collapse problem in the U.S. as well as in many other countries. And then the question is, how do we increase population growth in a way that is socially sustainable? And, you know, we could just increase birth rates. That is one solution. But, of course, newborns don't work. They temporarily remove their parents from the workforce. They also, you know, very predictably grow biologically old and chronically ill. I was always fascinated by this question of how do we improve our demographic makeup? I remember learning in maybe age nine or 10 that Japan was going to go extinct as a country. And that really stuck with me. It was like, wow, you know, a whole country could go extinct. But then I very quickly. And that's, of course, like, referring to the fact that their birth rate is quite low.

Their birth rate is quite low. And then the population is aging very rapidly, right? And so I really came at it from a bioethics perspective thinking, is it better to create new humans from scratch or to invest in existing ones? And, you know, we're not tangible tokens. we're not things that can be just like replaced. So it seemed to me a smarter strategy to invest in humans with fully grown brains than to just count on higher birth rates, right? And those are not mutually exclusive.

You can invest in existing humans while increasing birth rates, right? If you delay menopause, you will slightly increase birth rates. You can do both at the same time. And I think the beauty of research on the biology of aging, is that you can simultaneously improve mortality, productivity, and fertility rates all at once. So I love that. And I guess just to kind of help people understand where this conversation is going, I want to do a quick, rapid fire, high level. So try and just keep your answers to true or false. And then we'll kind of dive into the details after. But true or false. Aging is the deadliest and

least funded disease in human history. I would argue if you consider it Aging a disease, true. Yeah, it is certainly the biggest source of suffering, I would argue, in our species. It's, you know, something that is, we know, malleable. And then, yes, it is a huge cause of suffering, maybe the primary cause. Well, let me add one in that. True or false. Is aging a disease? So the Merck Manual of Geriatrics considers something a disease if it affects less than 50% of the population. Oh, interesting. I don't think that's a great definition, right? Because, over a long enough time span, we're all going to get some form of dementia, some form of cognitive impairment. Right, if you lived long enough.

Yeah, if we all lived long enough, we would all get Alzheimer's. So, you know, is that not a disease? Because eventually that becomes a universal problem, I'd argue that because aging is universal, that makes it more, not less morally and economically pressing. And, you know, I think we don't have to call it a disease in order to come up with the mechanisms that allow us to improve it. But you could. You know, scientifically, there's no good reason why you wouldn't call it a disease.

But from a public perception standpoint, I don't know how helpful it is to pathologize it. It's so interesting. So it's not technically a disease because it's inevitable. But if we chose to treat it like one, it would be the answer. You would say trick. Right. And, you know, at some point in that time span, you know, if 51% of the population eventually had their biological aging improved,

then you could argue, you know, oh, now it is a disease per that definition. Building on some of the stuff that we've already touched on, you know, true or false, if people lived meaningfully longer, let's say 50 or 100 years longer than they do right now, we would have to wildly rethink our understanding of ethics. I think we would. Yeah, I think we've come to think of aging as something that is undivorcible from life, something that's almost like, oh, the alternative is death. So why wouldn't we all want to age gracefully and to live to, you know, a merry old age?

But I think there will increasingly be new alternatives, right? We already age a little bit better than we did even just 50 years ago because we now we've embraced the idea of running as a species, right? If you've read the book by Phil Knight on Nike, it was a thing that was not very common 50 years ago. So we are slowly improving, extend your health span. And as a result, we age a little bit better. Yeah, I think it's interesting what you're sort of picking up on that, you know, we used to sort of run a lot in just in the context of survival and life.

And we needed an entirely new attitude about running when, you know, our lives became so hyper convenient that unless we kind of conceived of this whole idea of, you know, leisure time exercise, we were going to be, you know, increasingly unhealthy because life is like. like too easy. And I think about that a lot. I mean, just this week was the announcement of these neo robots. Did you see this? They're like, I think I did. Yes. It's like all over the internet where it's this very, I think it's a five foot six whitish gray robot, incredibly humanoid looking that is supposed to be trained to do household chores. And it's in beta right now. shipping in I think, I think this, you know, 2026, the advertisements show it, like, doing laundry and doing dishes and fetching you a beverage and you see in this beautiful, like, mid-century modern home, somebody, like, you know, chilling in their lounge chair as like, I think water or coffee

or something is brought to them and just, you know, I think there's that like end state, like, Wally where it's like, we're all just like, you know, being served by the robots and, you know, don't need to lift a finger for any element of life. If we don't intervene to make things that used to just happen naturally in the course of keeping ourselves alive. If you don't sort of reframe how they show up, we're going to become very sedentary and all those things. Just think super interesting. So how do you think about this? So like what are some of the places where ethics and lifestyles and culture are going to need to evolve around an extended lifespan? Yeah. So my biggest bioethical concern when it comes to human longevity is just that 20, 30 years are going to go by and we're going to get more

unproven supplements or more treatments that at best extend our unhealthy lifespan by a handful of months because that's what free markets mostly optimized for. So the biggest bioethical concern is not so much that this is not going to benefit everyone. In the U.S., more than elsewhere, a huge factor why people don't live that long in certain neighborhoods is because we drive a lot. So the more you drive to work, like in a life expectancy calculator, one of the biggest factors that will influence your life expectancy is how many miles you drive per week. And is that because of how deadly auto accidents are or like the stress of commute? That's a good question. I don't know how to answer it. But yeah, the fact that we drive a lot

and then we do have a pretty substantial opioid crisis. So, you know, unlike in other countries, You know, a lot of people think that like if gross domestic product is such a good proxy for human flourishing, then how do you explain the fact that the U.S., the country with the highest GDP per capita, has a lower life expectancy than countries in Europe? But the answer there is there's a lot of inequity in the United States specifically. Because again, if you look at the wealthiest neighborhoods in the United States, they have a really, really high life expectancy. No, if we really had a therapeutic that could reliably delay age-related decline, then governments would have a lot of incentives to subsidize them, just like they did with like the COVID vaccine, right? It cost the U.S. government about $18 billion for Operation Warp Speed. And then the vaccine was rolled out at about $2 a dose. And that's something that, you know, we appreciated how urgent that was as a country.

And the same, I think, would need to be true for us to arrive at a future where health-extending therapeutics actually benefit those vulnerable populations. And that's why I do think more work needs to be done on how we understand aging, biology, as a field. Because right now there's this perception that it's only going to benefit the top 1% of our civilization. But that's only true if we don't really encourage our government and really, like, pressure our government, really, to create the solutions in a way that will benefit everyone in a way that is a social good as opposed to, you know, more therapeutics that extend our unhealthy lifespan or more unproven supplements. Yeah. And I'm wondering if you can expand on this idea a little bit because one of the things I hear a lot is that, you know, all of this longevity stuff is just this sort of weird hobby of billion. millionaires trying to live forever. And I think a lot of people hear longevity or longevity supplements, and they roll their eyes a little bit at like, you know, billionaires wanting to be immortal.

But I think that that sort of gives this whole field a bad rap. And in fact, a lot of the things that maybe somebody is selfishly interested in their own immortality, but actually does have really meaningful implications for, you know, everybody having a healthier or marginal decade of life or something like that. So wondering if you can just kind of expand on that. Yes, I think there are two questions there. First, I do think we have a pretty well-documented snake oil history in longevity. It's a young field. So we don't have a lot of human relevant results, right? We have a lot of results proving that we can reverse biological aging in animals, depending on how you measure aging from mice to non-human primates. We've extended the lifespan of Cielligan's worms by about 400%, which is

pretty stunning. It's the equivalent of a 400-year-old human roughly, depending on how long you live. We don't have any results in humans just yet, but from the fact that we don't currently have results in humans, it doesn't follow that we couldn't produce human relevant results. I think there's there's a question of how do we perceive this field as urgent enough that we invest enough public funds in order to create the technical results we need. Because if you think of an industry like Alzheimer's, they have maybe fewer credible results than we do in aging science. They have, you know, an equally well-documented snake oil history. And yet we wake up to $3 billion a year in public funding for Alzheimer's disease. And about, you know, as of 2023, 500 million a

to fundamental research from the biology of aging. So I think we're going to need to, in order to produce the technical results that satisfy everyone and that actually benefit everyone, we're going to need to care more about it and to just appreciate it as a morally and economically urgent problem. I don't think that that argument has compellingly been made just yet. Yeah, so I think you touched on a couple of really interesting things, which is that, you know, we fund aging at roughly 1-6th the rate that we're funding Alzheimer's. And yet we all age. And you touched on earlier in our chat that if we could delay some of the,

you know, negatives that are happening as we age, we could have, you know, solve a number of different problems from reducing the cost of health care to, you know, extending childbearing years, which would solve some of the population collapse concerns and all of those different things. And, and you touched on the fact that aging research is really difficult because, while we can do things in Cieligans that have very, very short life cycle, so easy to kind of have a bunch of iterations when you're talking about human lifespan where, you know, roughly 100 years, the sort of time to prove that you made somebody who would have died at 90 instead die at 110 is, you know, I can't wait a century funding cycles don't work like that. And so I think this is a great segue to move to

the work that you did with the XPRIZE on health span. And what problem were you trying to solve? You know, you created this $101 million prize. That's the largest prize ever given for any scientific funding. Is that right? Yeah. It was the largest science prize to date. So largest science prize to date. So huge deal.

What were you hoping was created in competition for this prize? Yeah. So the big question, no one in the field has been able to answer just yet, is what do we mean when we say biological aging? How do we measure it exactly? You know, we have some good tools today, but a lot of the literature has conflated health with biological youth. So you can be both young and unhealthy or old and healthy. And if you conflate the two, if you just say, you know, you need to look at your health span and you ignore the fact that, you know, from a disease standpoint, it's far better to be a chain smoking 30 year old than you know. You know,

it is to be an athlete at 80. Sure. So it's, we need to just appreciate that when we're talking about improving the way we age biologically, we're not talking about being healthy for your age at 80 because that would be disappointing, right? No matter how you cut it, someone at age 80 is just not going to be, you know, able to perform. But you're at higher risk of everything.

Yes. Yes. Yeah. Yeah. Yeah. Your odds of dying go up literally exponentially between the age of and 80. So we wanted to, first of all, understand what we mean when we say biological aging. So we came up with a bunch of smaller prizes that would allow us to basically come up with milestones

to say, you know, this lab has been able to validate this biomarker of aging. And I should say that I left the XPRIES Foundation a couple of years ago and much has changed since then. But, you know, I was working with the team that was just brainstorming. And I did. different ways to come up with this prize. And we decided that it would be intellectually honest to say we don't actually know how to measure aging very well as of 2023. So the first thing we did was like let let's just award some small labs and companies some smaller prizes. And then by the end of this decade, we'll come up with a grand prize that will, in fact, measure age reversal by 10 to 20 years. I mean, you know, depending on whom you ask at the expert.

foundation, they would say age reversal or just improving how we age. Because reversing how we age is a little bit more difficult, arguably. Yeah, I think one of the things that you're touching on that's so fascinating is this idea that like we don't even really know what aging means other than there's a sort of vague understanding that you get older and older and older and then you die. And so there's this huge interest in saying like what are the biomarkers that I can measure on the order of six months or a year or something like that and say this tells me that somebody's going to live longer without having to wait for that to happen. And so that's sort of like the holy grail of this space right now is can we find these biomarkers that we can track in a short time and say that our

intervention is working. Right. Because it would, you know, it could take two to three decades for us to run a really thorough aging trial without excellent biomarkers of aging. And of course, we do have, you know, some surrogate endpoints like you could measure someone's walking speed, But that's really, really archaic, right? I think we can and we have to do better than that. There's this narrative that the pharma industry won't solve this problem because they're evil. But I think it's a far more complicated problem than that. Like we like creating these stories with a villain and a hero, but it's not at all what's going on. You know, the pharma industry, if anything, I believe in what Peter Huchensky calls the Massachusetts paradox.

He basically says, you know, we are the biggest life-saving industry. state maybe on planet earth, and yet we're seen as the villain. So there's a clear mismatch in how the public perceives the pharmaceutical industry and what it's actually doing, when in fact, you know, insurance companies are often benefiting far more than pharmaceutical companies are. And when you think about a clinical trial and running a clinical trial for aging, you know, the counterfactual to what would happen to a patient if you just left them alone is kind of unknowable. So it's far easier to measure disease than it is to measure improvements in how we age and health span, right? Health is this almost fuzzy thing. We don't know how to

measure it exactly. So it's easier just technically to measure disease. And as a function of how it's easier to measure disease, pharmaceutical companies flock towards it. We have very clearly approved regulatory pathways. It's much cheaper. So of course, they would, you know, extend someone's lifespan by two months and, you know, allow them to live with cancer for a little bit longer and they wouldn't get in the messy space of extending your health span by 10 years, right? So it's odd, but free markets surprisingly maybe optimize for drugs with smaller effects on health span. It's kind of a tragedy of the comments because we would all benefit from longer healthier lives in the long run. Governments would benefit, families would benefit.

You know, today we have some 40 million Americans who are unpaid caregivers of older adults at roughly a $500 billion a year opportunity costs. And there's no agency in charge of that, right? We have the National Institute on Aging, but most of their programs are designed for late stage diseases, for late life diseases like Alzheimer's that will, you know, eventually happen to all of if we live long enough. So we need to be detangling the question of healthy aging brains versus, you know, abnormal aging. There's a blurry line between what's normal and what's abnormal when he comes to biological aging. Yeah. And I'm on the board of Archangels, which is a local startup focused on the unpaid family caregiver space. So it's a problem I'm deeply familiar with.

And I think what you're getting at, which is, I think, really underappreciated, is that all of this disease that, you know, a lot of times we talk about what it does to the individual. It takes them out of the workforce and has a bunch of health care costs and all of those things, but it's really easy to miss the fact that it often takes their family members out of the workforce, too, as family members try and keep those people home and, you know, take care of them in a way that is very much invisible labor. And as you have more and more, you know, this generation that are having their kids later and then they're having kids. later, you start to have more of this is what they call the sandwich generation. So aging parents

and young kids at the same time, and these people are really squeezed on both sides to come out of the workforce, and there's huge economic costs to not supporting those people. I'm curious, like, to continue to expand on this idea that the pharmaceutical industry is not currently incentivized. And I think, you know, you were bringing that up in the context of things like the XPRIES may be coming in to create incentives where our current system is missing them. where are there huge funding gaps and where should people who care about the problems that you're raising think about directing philanthropic efforts? Yeah, so I think fundamental research on aging science is vastly underfunded. I did interview 102 scientists working on the biology of aging and ask them essentially, you know, what are R&D approaches that are underserved by commercial incentives but could result in outside.

social returns. And the answers ranged from ovarian aging and mapping the causality between aging ovaries and a shorter health span. Female health is just vastly underserved in general to the novel concept of replacing aging. So this idea that even if we can't fully map out the biology of aging in the near term, like we could, for instance, with the human genome project, map out the human genome, we could still replace its parts. We could replace aging cells and aging tissues and that's a technically more solvable problem a lot of people in the field seem to think. The solutions we need are messy. They're not as clean and maybe exciting as a lot of funders would like to think. You know, there's a lot of funding going into epigenetic reprogramming,

this idea that we could come up with some sort of holy grail solution that would reverse biological aging with, you know, maybe one therapeutic or a combination, a small combination of different interventions. And that would be wonderful. You know, I think it could happen and it likely will happen in the long run. But in the shorter term, there are people dying every day. So we still need to replace organs and we still need to come up with solutions for the people who are already 70. And, you know, maybe we won't be able to reverse their aging in the next decade. What's up, folks? If you are enjoying this podcast or if you care about health, performance, fitness, you may really enjoy getting a whoop.

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You've touched a couple times on this. idea that like the person who's 80 and still exercising and, you know, really healthy for an 80-year-old is still kind of worse off than the chain smoking 30-year-old. And I'm curious for people who are listening to this and thinking about their own health span and their own longevity. What's a good framework for what we do know? How can they, like, cut through a lot of the snake oil, maybe people who don't feel like they have a lot of time to just try stuff or all of those things.

Because the 80-year-olds who's exercising is far better off than the 80-year-old who's chain smoking. Yes. So to what extent with today's technology, do people have agency to extend their own lifespan versus are we just kind of waiting for breakthroughs and molecules that don't exist today? So the sad news is that the state of the art when he comes to longevity is exercise, a diet. But that's also happy news, right? Because we can all work on it. We can all use our wearables and rely on them to get as much data as we can and to inspire us to do better. We actually – so I spent the last two years working with a team of economists to basically simulate the economic returns from specific advancements in aging science.

We did learn that – we didn't learn this is not unique to our project, but we arrived at a number for – adopting regular exercise for the entire U.S. population. And if you combine exercise with diet, there's hardly any therapeutic intervention that would provide a greater benefit, you know, in this decade than exercise and diet could. The numbers are astounding. It would add more to the U.S. economy than curing all cancers. And by the way, you know, if we eradicated all cancers today that would add between two and three years to life expectancy, not all of them, healthy years. So it's of disappointing, right? What we can do by targeting individual diseases. And then if you really deeply care about how you age, I think the single best way to change it is just to work on the

field and to, you know, either work in policy or work on fundamental biology or join a startup and maybe, you know, some epigenetic reprogramming intervention is going to work and just help us all age better. So I want to give you a hypothetical magic wand to wave now. You said work and policy. What are the policy issues that are holding us back right now? So one problem that's very close to my heart is what I call the pair problem in longevity. We would all benefit in the long run from longer, healthier lives, but no individual agent has the incentives to shoulder the costs of development in the short term. So, you know, no single insurance agency will invest in validating aging biomarkers because we are all free to change our health. health insurance in a year. No federal agency sees itself as just fully responsible for making

us all age better. But if you think of something like the Center for Medicare and Medicaid, there should be a way to just put a price tag on, you know, if we could extend healthy lifespan by a year, we could just dramatically reduce Medicare costs because that's a population of, you know, 65 plus. And how do we get them to subsidize this development? because they would directly benefit, right? So how do we get the players where incentives are aligned, right? Because not all incentives are misaligned. So how do we bring the right people to the table to say, let's solve this problem in a way that benefits you?

So I'm confused why sort of free markets can't solve this problem? Because I think for decades, people have been saying that if we could just cure obesity, like all of these issues would be solved. And then, you know, in-walk, GLP-1s at $1,000 a month, very much funded by. private pharmaceutical companies and, you know, incredibly effective, quote unquote, miracle drugs. Why isn't anti-aging drugs seen by pharmaceutical companies in the same way? In the long run, the biotech that creates a therapeutic that reverses biological aging will be the single most profitable life sciences company of all time. Because in a lot of ways, right, isn't a GLP1, like kind of a longevity drug?

Yeah. And in the long run, again, the key part of the answer here is in the long run, they will be the single most profitable life sciences company of all time. But how long that long run is can be influenced by policy and will be influenced by policy and by how we perceive the problem to either be morally and economically urgent or to be something that we shouldn't reallocate resources and we shouldn't really prioritize on the top of our list of priorities as is being. Because if we do that, if we truly prioritize it, then we could cut that timeline by, you know, by the end of this decade, we could come up with a therapeutic that reliably improves how we age if we play our cards, right? But of course, I think the default future is one where 20 years go by and we don't have very many exciting results in this space. And why is that? Again, because there's just very clearly approved pathways, regulatory pathways for drugs that target disease. It's just really, really easy to target disease and really, really hard to come up with a definition of aging and really, really hard to run a clinical trial that reliably targets how we age.

So there is the targeting aging with metformin trial. And, you know, their approach is let's just use an FDA-approved therapeutic. Metformin to improve how we age. And I think it will probably work if they get the funding for it. I actually worked with a team of economists to come up with the returns on investment for that trial. The trial would take about 50 million to conduct. And the returns on investment would be about $40 billion per year if we could get the wider U.S. population to adopt metformin for people aged 65 and older, which is where the benefits largely out. weight the risks and there's a, you know, well-proven safety profile from it foreman. So the returns

far outweigh and just dwarf any plausible investment amount. But, you know, that's an example of a trial that's been trying to fundraise for the last 10 years and they just have not been able to because most billionaires in the space, they want to come up with solutions that sound exciting and that will benefit them in this decade, right? Rather than, you know, let's fund this trial that's going to take six years for us to arrive at results and then we'll come up with new solutions. It just seems slow to most funders in this space. And that's, I think, proof of how there's a market failure. So the interesting market failure here is that it just takes too long and people want sexy, shiny new things. And Metformin, which has been around forever, is just like boring.

Yeah, I think so. Although at the same time, most billionaires got to be billion. millionaires by being sort of financially savvy. And what you just described is like a pretty good six-year ROI. So is there something else going on there? Yeah, but the six-year ROI that I described is actually on the population level. So it's an aggregate in gross domestic product terms. And no individual agent is going to benefit from that in the short term. Is Metformin generic now? It is. Okay. So. And, you know, repurposing generic therapeutics is not something. with a particularly high ROI for, you know, one individual agent. But for a society as a whole, definitely.

Yeah. It's interesting when you think about, you know, metformin, for those who aren't familiar, is a diabetes drug. That was actually at a conference, gosh, like almost four years ago now, three and a half years ago called Life itself, which kind of used to be Ted Med and then got somewhat repurposed. And it was a ton of fun, but it was, you know, 500 people out on an island off of San Diego for a week. who are all kind of gurus in the longevity space. And everybody was on metformin as a sort of longevity drug.

And people were just starting to talk about things like rapamycin and all of those. And it kind of blew my mind that people were taking diabetes drugs when they weren't diabetic and sort of the interest in this space. But, you know, it is sort of generally understood to be safe. There's one meta study with over one million participants that proves that especially if you have some pre-execisement, this thing condition of aging, like if you have cardiovascular disease, it will lower your mortality risk quite reliably. That's one million participants in a meta study. So, you know, four people age 65 and older, I think the safety profile is maybe the most well established of all therapeutics. It's a good bet for longevity. And, you know, I do think the GLP 1 Agnizs

are a kind of, there's certainly a health extending therapeutic. Now, it remains to be seen whether they're actually targeting the biology of aging, and we'll find out very soon. Since you brought up GLP ones again, I'm curious how you think about, you know, because you study the ethics of all these things. And I think some pushback that the GLP ones get is that, you know, people take these drugs to lose weight instead of dieting and exercising. And that sort of gives them, you know, the moral permission to not do those things. And, you know, we've also talked about how no drug that exists is nearly as effective as, you know, good nutrition and good exercise. And so how do you think about kind of that, like the moral hazard of, you know, we solve

these things with drugs and then people no longer incentivized to do the things that they need to do and maybe they eat even worse or something like that. Yeah. So I think there's a, there's a blurry line between health and illness, right? We usually come up with therapeutics, with interventions to treat ill people. But then very quickly, once the safety is established enough, we start using it in a less clinical way, I want to say. So if you think of like nose jobs, they started in World War I.

Soldiers were basically coming back home with wounded noses and their wives realized that their noses look better. And then very quickly they started thinking, oh, maybe we can, you know, not just do this clinically to save the life of someone who's suffering, but also just to make someone feel better and more beautiful. And I don't know that I have an in-principle objection against people feeling better. I think people should feel better. So if we're able to diminish suffering with GLP1 Agnes for people who do feel horrible about themselves and their body, I think, you know, if it's safe enough, we should do it. But the question is, is it safe enough? And I think much of ethics can be reduced to just

safety, efficacy, and affordability. If you can get technological intervention to be safe enough, effective enough, and then maybe affordable enough, you can usually calm all the qualms that people have about a solution. So another example I like to give is just birth control. We could naturally abstain and not have babies if we wanted to, but there's just a clearly superior way to do it with an unnatural therapeutic. And now most of us accept it, right, as a given that women should be able to take them by 50 years ago. It was not the case.

Right. And I guess in that case, too, that, like, the risk profile is justified for, you know, the positives of nonproductive sex. Yeah. And I mean, it's no coincidence that the safety profile has improved. And then we started thinking of birth control as like, oh, it's this thing that you. you just take. And, you know, there are risks because it's medicine. It's not magic. So there are side effects, but the side effects by and large are not as high as the benefits. And, you know,

birth control forever changed female workforce participation. It changed the world as we know it. It, you know, it produced so many scientific discoveries. It allowed us, you and need to be in this room today. So it's just a mind-boggling innovation. And I think we should celebrate those. And, you know, again, you know, the word ethics comes from the Latin custom or habit. So what is ethical is what has been customarily done often for millennia. But I think we can do better than that. And we should.

So I want to close the loop before moving on just on the Metformin point. Like we know that it improves metabolic health. We know that recent studies have shown that only about 6% of Americans are metabolically healthy, which is tragic. We released Woop Advanced Labs, our blood work feature recently, and have been totally mind-blown looking at and not ready to share the specific numbers. But we are doing better than 6% on the Woop population, but not nearly as well as I would have thought, just in terms of the number of people who are showing signs of not being

metabolically healthy. And so even in people who are exercising and sleeping and, you know, sort of outwardly healthier than the average population. We're definitely seeing signs of population level poor metabolic health. And then, of course, metformin's been shown to be protective against heart disease, and we're seeing loads within our advanced labs data as well as just what we know about the U.S. and the global population. These are huge problems. Why isn't our Medicare system incentivized to cover for all Americans age 65 and up the way we do with COVID vaccines and flu vaccines and flu vaccines, this incredibly affordable generic drug because it's like less than a dollar a day.

This isn't a very expensive disease. But I think something like one in four health care dollars are spent on the complications of, you know, type 2 diabetes, which is, you know, poor metabolic health. Heart disease is still the number one killer in that age group. So why don't those economics work out, especially given what you've already shared about the incredibly promising a safety profile. Yeah, so I could offer up a number of answers to this question. One of them, you know, if I had a magic wand and I could delete just one bias off of human civilization, it would be this idea that what is natural is morally superior to what's unnatural. I'm maybe among the more contrarian bioethicist and that I believe that if we did have a pill that would allow us to

mimic perfectly the effects of exercise and a healthy diet, then we have. a moral duty to take it because, you know, we're going to be reducing Medicare costs. We're going to be able to reallocate those public funds in a way that benefits more people. But we don't, right? We don't have a magic bill that does that just yet. And why don't we, like, why does Medicare not subsidize it? I think in part it's just the tragedy of the commons problem I described. You know, in aggregate, it would benefit the U.S. society and population. But, it would be really hard. You'd be hard pressed to find, like, one individual agent, one health insurer who would benefit

from shouldering the costs of this investment in the short term. In the long run, everyone would benefit. But in the short term, who subsidizes, you know, validating biomarkers of aging is a question nobody has a good answer to you. But that's why I'm always surprised that Medicare doesn't do this because I totally get why my private insurer, you know, as provided by WOOP, thank you, Woop. doesn't cover some of these like longevity things because, you know, the average tenure of an employee at a given company is about two and a half years. So when you're talking about an employee

provided insurance, they're really incentivized to think about what's going to be my problem in the next two and a half years because likely, you know, this person's going to work for someone else and switch providers and, you know, whatever. And I think that has its own issues. But by the time you're 65 and on Medicare, Medicare expects to have you for the rest of your life. And for your cost per care per year to go up every year, right? And so isn't something like Metformin going to save them money, not just short term, but like their own money? Like why isn't whoever runs Medicare incentivized to do some of these things? You know, I think an easy answer is just, you know, it's no one wants to be the person who risks getting a lawsuit because they came up with the idea

of, you know, administering Metformin to all 65 year olds. You know, let's just let things be as they are. that always seems just intuitively morally superior to intervening. It's like the trolley car problem, right? If you have to like pull the lever, you're a bad person, which I disagree with. This is so interesting. And I'm curious, the problems we've identified so far are just like these crises of ownership. And it's sort of nobody's job so it's not happening, even though it seems like if somebody were to bother to connect to the dots, like the dots are there to be connected.

And so to what extent is there some government or system that's like set up better than ours for this purpose, so just differently from ours, where this is happening or is this sort of a universal problem? It's a good question. So you could argue that in Europe there's less of a transfer of accountability problem because they don't go from like, you know, paid health insurer to Medicare. It's all kind of public. But we've never quite run that experiment perfectly because the U.S. is the country in the world where you do innovation the way that we do. For now, we're number one in the world. So we don't know what would actually happen if we had less of a transfer of accountability problem in the U.S. We don't know what would actually happen.

Because in the European models, while they don't have a transfer of accountability problem because they have national health care systems, they also don't have the infrastructure for innovation in this. way. But I mean, loads of Europeans can read American medical literature. They have Metformin, like, not to keep picking on Metformin because I know it's just one of many examples, but like to what extent, why can't they do some of these things? Is there a reason they're not? I do think it's a question of why is there no innovation in Europe and the way that there is in the United States, like why are there fewer startups? Why are there just fewer people doing crazy, bold things in general? So I don't think we're going to solve that problem for Europe. I think it's likely that the U.S. is going to come up with some solution for Medicare and Medicaid comes up with a peer system where we say, you know, we could, in fact, reduce Medicare costs by this amount if you guys fund this project.

And I think we're slowly headed towards that world. I'm hopeful that, you know, is one of the many billionaires out there listens to this and decides to fund it because. Yeah. And, you know, I always like to say that the future is not predetermined in any way. Timelines for scientific breakthroughs are malleable, and they're very much a function of talent, resources, and human ingenuity broadly. They're also a function of just unforeseen technical problems and moral prejudices. We, you know, we have a bunch of moral prejudices as a species that kind of dictate what we prioritize. If we could actually go back to the question of what bioethics means, I mean, there's arguably no question more important than what we should do as a species, right?

But there's no one in charge of it. There's no single federal agency whose job it is to say, you know, let's quantify the returns on investment for these solutions versus these other ones that we have currently underway. And I think that's what we should be thinking about. I love that. As we wrap up, I'm curious, for those people who. are listening and thinking about the role that they can play. What do you wish more individuals understood about the longevity and aging space? The bad news is we have nothing that works in humans when it comes to advanced science yet, but from this, it doesn't follow that we can't develop

solutions that do work in humans and that we shouldn't. We similarly don't have anything that works superbly well in humans for Alzheimer's disease, but we have the moral and economic urgency. We appreciate it's a huge problem that we can and should solve as a species. And I think we should think similarly about aging biology. You know, it's not a problem where we do have the technical solutions. But if we just keep waiting for the technical solutions to spontaneously emerge from, you know, private markets or venture-funded companies, we could wait decades. longer than we would if we instead thought about it the same way we did about COVID, right? Let's

fund the solutions to this problem that we know is huge even though we don't have them just yet. You mentioned that you spent the last two years working with the team of economists and that you've been simulating and running different models about you mentioned like if we cured all cancer instantly that would add about two to three years to everybody's or to the average lifespan. Tell me more about this tool. That sounds really powerful. Yeah, so we, I basically interviewed 102 scientists to map out timelines, funding needed, just what would be required for us to arrive at breakthroughs in aging biology, and then from there, what would be the returns on investment for those specific breakthroughs?

So what would happen to the U.S. population and economy if we could reverse brain aging by a year versus reversing a variant aging by a year, how many lives could be saved or create, and how many dollars could we add to US GDP? And unsurprisingly, the aging organ with the single highest ROI is the brain because, you know, most work today is cognitive and you get just an immediate return on investment by investing in existing humans with fully grown brains as opposed to creating them from scratch. And that seems important to me, right, to value existing humans a little bit more highly than we do potential new ones, future humans. So, you know, my discount rate is a little bit higher than a lot of people's in that regard. I think we have a moral duty to care

for our older adults, you know, not just because they're 80 now that we should stop caring about them. And in fact, from a GDP standpoint, investments in brain aging are more valuable to the economy than almost anything else because we usually peak around age 58 income-wise. So most of us will make the most we ever will around age 60 or so. And then our income will predictably decline. So from a GDP standpoint, adults aged 50 and 60 are more valuable to the economy than adults age 20, which is pretty stunning, right, if you think about it. Right.

So I actually think this is an incredibly important point. I want to kind of double-click on it for a couple of reasons. So it's not surprising to me that extending brain function is the most ROI positive sort of organ life extension because if I make my heart 5% more efficient or effective, I might be able to run faster or more comfortably walk upstairs, etc., etc., but there are very few jobs where that translates to my earning potential. But if I can improve my cognitive function, it's very easy to understand why I might perform better in. income earning activities, right? I literally get paid to come up with cool algorithms and to be creative and all of those things. And so many of us who do cognitive heavy work, right, lawyers that come up with better arguments are going to make more money. Doctors that figure something out faster are going to save more patients, all of those things. So you totally get why brain

translates to income, translates to GDP and all of those things. But one way to think about this idea is like, so let's say we figured out how to, you know, stall cognitive decline. So if our brain functions peaking at around age 58 or something like that. And let's say instead of starting to fall through, you know, the next seven years or so through retirement age 65, you could extend my performance at 58, just flatline for another seven years or something like that. That almost suggests that like chasing quote unquote longevity is silly and instead we should just focus on the much more tangible problems of delaying cognitive decline. And and then it kind it goes back to, you know, all of this, you know, Alzheimer's so well funded and all that. Well,

maybe that's actually the best way to go after longevity and I'm curious if you're going to tell me that I'm thinking about that wrong. The thing with your argument is that healthy people don't normally wake up dead. So, you know, if you keep someone, in fact, healthier for longer, they're likely to wake up alive the next day. And you're also required, like life is the thing that precedes all other things, right? So in order for you to have an income in the first place you need to be alive. I do think that, you know, in the short term, we're going to be looking at very high economic returns from reversing overall brain aging. And then we're going to be able to reverse overall aging, biological aging, and maybe we can reverse aging by 20 or 30 years. And I do

see a future where we're going to have to just flip social security on its head because right now we subsidize the decline of older adults. I think in the future, we're going to start. subsidizing the development of younger ones. You know, right now we spend by 2029, the U.S. is going to be spending about a full half its federal budget on adults age 65 and older just with programs like Medicare and Social Security. How do we make a dent? You know, the closest thing to an economic free lunch we can get is just letting people work in good health when they want to.

And in order to work, they need to A, be alive. And B, more often than not, they need to be healthy, right? So I think being alive and being healthy are two prerequisites to that equation. Well, definitely not going to argue with being alive being important. If you think about specifically those problems of like Medicare costs and Social Security costs becoming out of budget, to what extent is the most important lever to move cognitive performance? Because that does seem like an easier problem than aging globally. I don't know that it is an easier problem because we've been trying for decades now to, you know,

target Alzheimer's individually and we've been failing at it. We've been investing quite heavily. Almost all developed countries have been investing really heavily in targeting Alzheimer's as a single disease. And we haven't come up with very good solutions for it. So, you know, that you could explain it by just like some fraud. And we all know that there's a pretty reliably documented snake o'clock. history in Alzheimer's, but in aging bio, I just think we have far more low-hanging fruits to be discovered because not much has been tried, right? There have been so far zero clinical trials on the biology of aging. I think that's a pretty profound statement. There have been zero clinical trials. I don't know that most people know that. You could count GLP-1 agonists as a

drug for aging, but it has not been designed to target aging, right? So that's a, pretty big difference. That's interesting. So you could repurpose therapeutics. You could repurpose metformin again, and you could get just an astounding return on investment from a social standpoint. But we've never come up, you know, as a government, as a society and said, let's develop a therapeutic to improve how we age as a species that has not happened. I'd love to take us end on an optimistic note. So what are you most excited about in this space? I'm most excited about the amount of talent that's coming into the space. I just increasingly see incredibly talented young people. You know, I count myself as one of those, hopefully. I count you as an incredibly talented

younger. But yeah, they're even younger people than myself, just entering the space. And now it seems to be less of this fringe industry and more of, you know, of course we should improve how we age as a species. There's like the aging initiative at Harvard. There's a club where, you know, dozens of young people were super excited about understanding the biology of aging and coming up with policy solutions and ideas to improve how we age. So I'm immensely excited by just the endless possibilities of how we're going to age as a species in a decade or two. I love that. Well, Rainy, thank you so much for joining me on the podcast today. Thank you. For people who want more Rainey, where can they find you? You can find me on X Rainy Romani at LinkedIn. And then my book,

It's coming out with Harvard University Press. It's going to be called Redesigning Aging, the Ethics and Economics of Human Longevity. And I have two co-authors as well, Jason DeBacker and Richard Evans, who are economists. Amazing. Well, I'm so excited to read your book. It's very excited to see what comes next in the world of longevity. Thank you so much, Emily. It was wonderful being with you here.

If you enjoyed this episode of the WOOP podcast, please leave a rating or review. Check us out on social. At Woop, at Will Ahmed. If you have a question was answered on the podcast, email us. podcast at whoop.com. Call us 508-443-49-2. For anything about joining whoop, you can visit whoop.com. Sign up for a free 30-day trial membership. New members to use the code will, W-I-L, to get a $60 credit on W-W-Acessaries when you enter the code at checkout. That's a wrap, folks. Thank you all for listening. We'll catch you next week on the WOOP

podcast. As always, stay healthy and stay in the green.